Polyneuropathie vom Landry-Verlaufstyp bei allergischer Granulomatose und Angiitis (Churg-Strauß-Syndrom)

Two cases of neurological manifestations in eosinophilia: variations of one disease?

The hypereosinophilic syndrome is characterized by a long-lasting increase in circulating eosinophils in the absence of a definable etiology and by manifestations of multisystem involvement. It must be differentiated from the eosinophilia-myalgia syndrome related to the ingestion of L-tryptophan, although the clinical features may be similar. Two patients with hypereosinophilia not related to L-tryptophan intake are described who both became clinically symptomatic with neurological manifestations of acute and subacute onset: one with eosinophilic fasciitis and the other with painful polyneuropathy. Both responded well to corticosteroids.

[Diagnosis and therapy of Churg-Strauss allergic granulomatosis]

Three cases of allergic granulomatosis (Churg-Strauss syndrome) are reported. The patients all presented 2-10 years after the onset of pulmonary symptoms with a mononeuritis multiplex, accompanied by sharp pain in the extremities involved. In one patient, the neurological findings improved under treatment with corticoids and cyclophosphamide; the other two patients responded to treatment with thioguanine and cytarabine. In the first patient, the diagnosis was confirmed by a biopsy specimen of the sural nerve.

Sequelae of sural nerve biopsies

Sequelae of sural nerve biopsy were examined in 24 patients. Fourteen subjects reported persisting pain or dysaesthesias for more than one year. In nine patients the symptoms were mild, in five severe. Hypaesthesia of the lateral aspect of the foot was found in 17 out of 18 patients with otherwise normal or only slightly impaired sensory function. In one patient sural nerve biopsy did not cause permanent sensory loss. Pain and dysaesthesia were not significantly related to post-biopsy or generalized hypaesthesia.

Multifocal neuropathy with vasculitis in hypereosinophilic syndrome. An entity or drug-induced effect?

A 56-year-old male with a 2-year history of bronchial asthma, together with pulmonary infiltration and marked eosinophilia, developed a subacute multifocal sensorimotor neuropathy. Electrodiagnostic studies demonstrated both multifocal and generalized nerve involvement. Sural nerve and muscle biopsies revealed axonal degeneration with almost complete loss of myelinated fibres, lymphomononuclear vasculitis of interstitial vasa nervorum without eosinophils, and neurogenic atrophy of muscle without angiitis. Although eosinophilia decreased drastically with corticosteroid treatment, neuropathy rapidly progressed to total disability. The patient died from pulmonary embolism 4 months after the onset of neurological signs. Autopsy disclosed vasculitis of epineurial vessels of peripheral nerves and severe axonal neuropathy, particularly of the lower limbs, without vasculitis or other inflammatory lesions in any other organ system, including the lungs. Retrospective analysis revealed that the onset of pulmonary infiltration and eosinophilia coincided with the administration of cromolyn sodium (Intal), which is known to produce PIE syndrome (pulmonary infiltration and eosinophilia), vasculitis and allergic granulomatosis, while multifocal neuropathy with vasculitis appears not to have been reported in connection with this substance.